一位長期遭受家暴致重鬱症婦女創傷復原之照護經驗

A Nursing Experience of Assisting a Female Patient with Melancholic Depression in Getting Resilient from Long-term Domestic Violence

10.6847/TJPMHN.202012_15(2).05

洪楹棋(Ying-Ci Hong)；黃君代(Jyun-Dai Huang)

復原力 ； 重鬱症 ； 家庭暴力 ； resilience ； melancholia depression ； domestic violence

精神衛生護理雜誌

15卷2期（2020 / 12 / 01）

51 - 61

繁體中文

本文為一位長期遭受家暴致重鬱症婦女創傷復原之照護經驗。於2017年9月13日至2017年11月16日照護期間，藉由觀察、會談及整體性評估，歸納有二項主要護理問題：無效性因應能力／與長期遭家暴及缺乏社會支持系統有關；潛在危險性自傷／與憂鬱情緒有關。透過建立信任治療性關係及復原力運用，同理個案創傷經歷，護理諮商過程協助個案覺察自我優勢，發揮自身能力及可運用的資源，激發潛在能量；藉由家暴情境模擬提升對環境之洞察，進而自我學習負向情緒紓發與因應，肯定自我價值，維持家庭生活功能及人際互動的自信，擁有正向的態度面對家庭困境，住院期間未有自我傷害發生。建議臨床同仁運用復元理論於臨床家暴個案之相關照護外，學習護理諮商及心理劇技巧應用，適度轉介心理諮商師持續社區門診介入，協助個案在自我內在強化及家暴法之保護下，平安回歸社區。期能藉此篇護理經驗，提供臨床照護參考。

This paper is about a nursing experience of a female patient having serious depressive symptoms caused by long-term domestic violence. During the nursing care process, from September 13, 2017 to November 16, 2017, the holistic assessment under observation was conducted. We concluded two major nursing issues to be aware of, such as the patient's ineffective coping abilities related to chronic domestic violence and lack of social support systems, and potential danger of self-harm related to depressive emotions. According to the theory of therapeutic relationship and resilience, we have encouraged the patient to accept her traumatic experience, to acknowledge self-value and to develop social skills for problems solving. Through simulation of the traumatic experience to enhance better understanding of the environment, we have taught the patient not only to self-detecting emotions but also to cope with catharsis of negative feelings. Afterwards, the patient's sleep disorder was improved. It also enabled the patient to have positive attitudes while being in the predicament of frustrating marriage. It is suggested that clinical colleagues should receive educational training related to domestic violence and its therapeutic technique, including the psychologist's intervention to the nursing process in necessity and reducing the impact to the children who have witnessed the domestic violence.

1. 王秀美(2016)。受暴婦女走出家暴陰影的歷程分析。台灣健康照顧研究學刊，11，35-71。
   連結：
2. 林育陞(2018)。憂鬱症患者心理危機痊癒歷程個案研究 - 復原力觀。Journal of Crisis Management，15(1)，67-78。
   連結：
3. 洪玉恩,陳靜芳,陳昱芬(2016)。照護一位躁鬱症且有強烈自殺企圖病人之護理經驗。志為護理，15(3)，102-122。
   連結：
4. 彭美蓮,李衛華,賴芊孝(2018)。一位多次遭受家庭暴力的外籍配偶之急診護理經驗。導護理，19(1)，40-52。
   連結：
5. American Psychiatric Association,台灣精神醫學會（譯）(2014).精神疾病診斷準則手冊.合記.
6. Chang, H. Y.,Lin, C. Y.,Liu, S. Y.(2018).Three-tier five-level preventive strategy for domestic violence and sexual violence prevention in Taiwan.Journal of the Formosan Medical Association,117,176-177.
7. Herman, J.（編）(2018).從創傷到復原：性侵與家暴倖存者的絕望與重生.左岸文化.
8. Juchnowicz, H. K.,Łukasik, P.,Topolska, J. M.,Krukow, P.(2017).Risk factors of anxiety and depressive symptoms in female patients experiencing intimate partner violence.Psychiatr Pol,51(1),63-74.
9. Kumar, A.,Nizamie, S. H.,Srivastava, N. K.(2013).Violence against women and mental health.Mental health & Prevention,1,4-10.
10. Swailes, A. L.,Lehman, E. B.,McCall-Hosenfeldc, J. S.(2017).Intimate partner violence discussions in the healthcare setting: A cross-sectional study.Preventive Medicine Reports,8,215-220.
11. Tsirigotis, K.,Łuczak, J.(2017).Resilience in Women who Experience Domestic Violence.Psychiatr Q,89(1),201-211.
12. 全國法規資料庫（2015）．家庭暴力防治法 ．取自:https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode＝D0050071
13. 徐鳳蘭,鄭秀瑮(2017)。一位遭受家庭暴力女性之急診護理經驗。澄清醫護管理雜誌，13(4)，55-62。
14. 蔡宓苓(2013)。親密關係暴力與復原。社區發展季刊，142，136-142。
15. 衛生福利部保護服務司（2016）．家庭暴力事件通報案件統計．取自:https://dep.mohw.gov.tw/DOPS/lp-1303-105-xCat-cat01.html.
16. 蕭淑貞（編）(2017).精神科護理概論.華杏.

1. (2024)。運用復原力於憂鬱症女性遭受家庭暴力之急診護理經驗。領導護理，25(2)，66-79。